A 36-year-old African man, who is 1.8 m in tall, weighs 76 kg, smokes 20 cigarettes per day, and has no prior medical history, was assaulted with a sharp object. He was unconscious upon admission at a tertiary healthcare facility where his left leg was later amputated just below the hip joint. Two days after the amputation, the patient reported excruciating PLP along the length of his missing leg and toes. He reported a pain severity of 7/10 (on a 0–10 scale) and described the pain as shocking and cramping—as if the leg was being twisted. His pain was constant throughout the day and night, and without any notable relief. To manage his pain, he was initiated on Lyrica (25 mg during the day; 150 mg at night), venlafaxine (75 mg), and ibuprofen (200 mg). However, after seven days of treatment, there was no significant improvement in his symptoms. He was referred to the Pain Clinic at Groote Schuur Hospital for reassessment and management of acute PLP. On assessment, the Douleur Neuropathique four questions (DN4) questionnaire for neuropathic pain revealed a score of 4 out of 10, thus indicating the presence of neuropathic pain []. In this questionnaire, he reported symptoms such as hypesthesia to touch, electric shocks, numbness, and itching of the stump. The overall pain severity score assessed by the pain severity scale of the Brief Pain Inventory (BPI) was 5.5 (on a 0–10 scale) []. The individual components of the BPI showed that his pain (out of 10 in the last 24 hours) was five at its worst, four at its least, five on average, and five at the time of assessment. The pain interference score assessed using the pain interference scale of the BPI was five (on a 0–10 scale). Pain had a substantial negative impact on his sleep (9 out of 10) and his walking ability with crutches (7 out of 10), and had minimal interference with general activity (4 out of 10), mood (3 out of 10), relations with other people (2 out of 10), and enjoyment of life (3 out of 10). Because he was an inpatient, we could not rate the interference of pain with normal work. Therefore, the overall pain interference score was derived from six items of the pain interference scale. The patient reported primary hyperalgesia but no allodynia near the site of amputation. The visual inspection of the stump showed redness and swelling. On left/right judgements he scored: left limb 98%, time 1.4 seconds; right limb 100%, time 1.5 seconds. Imagined and actual movements (knee flexion/extension) of the phantom limb did not aggravate pain. The Tinel's test on the residual limb elicited a shocking pain radiating down the phantom leg into the toes. Treatment began with educating the patient about PLP and its underlying peripheral mechanisms. He was told in lay terms that spontaneous nociceptive activity at the site of the severed nerve may have a role in initiating PLP and that TENS may provide pain relief. The patient underwent high-frequency TENS (100 Hz) for 15 minutes, followed immediately by 15 minutes of low-frequency TENS (10 Hz). In both instances, the intensity was gradually increased three times to the highest tolerable level. The electrodes were positioned on the posterolateral aspect of the residual limb along the distribution of the sciatic nerve. At the end of the session, the patient reported complete pain relief and increased awareness of the phantom limb. In addition, the patient reported a high level of satisfaction with the treatment and its effects. Treatment was provided once a day for three consecutive days, following which outcomes were reassessed. The patient reported no PLP. Further, he reported that his sleep had improved remarkably since the first treatment session. At this point, he was mobilizing with elbow crutches under supervision. No adverse effects were reported.